Trusted Collaboration Is Key to Actionable Data: RISE National 2024

By Beth Friedman, Sr. Partner, FINN Partners
LinkedIn: Beth Friedman
LinkedIn: FINN Partners

This year’s RISE National conference took place in lively downtown Nashville. Regardless of the speaker, track, or motivation, the overarching theme of all discussions was trust.

Trust is vital for problem-solving in healthcare. This is especially true for the Medicare Advantage program. Whether between payers and providers, providers and patients, payers and members, or vendor participation throughout, each session emphasized the role of trust to share aggregated member data and improve care.

Highlighting this during her opening keynote session, Inspector General for the Department of Health and Human Services, Christi Grimm, emphasized trusted collaboration and the latest OIG efforts to ensure cost-effective and quality care for Medicare Advantage enrollees. Pre-conference sessions were also focused on health plan members with emphasis on new technologies, new regulations, and new partnerships presented through the event. Here are two valuable takeaways.

1. Manage member relationships: traditional outreach programs won’t suffice

Sunday’s pre-conference workshop, “Revolutionizing Health Plans: A Member-Centric Approach for Sustainable Success,” was covered by my colleague, Jillian Schmitt, Account Coordinator, FINN Partners. The workshop showcased a panel of health plan executives underscoring a consistent message: Plans can ensure health equity by correctly capturing members’ stories and personalizing care.

Members are core to health plan success. Essential member relationship management (MRM) programs must include tailored and empathetic care coordination, especially considering new CMS and OIG regulations including the Health Equity Index (HEI).

Here are five key points for health plans to consider:

  • Place members at the center of healthcare efforts for sustainable success and documented HEI outcomes.
  • Analyze data for better targeted interventions and outcomes from member engagement programs, especially with vulnerable populations, such as Medicaid or D-SNP.
  • Align enterprise programs with performance measures to improve care coordination, quality, risk prevention, and compliance.
  • Use a personalized approach when implementing health equity initiatives and understand each member’s unique story and barriers to care.
  • Shift from managing processes to managing results for improved member satisfaction and boosted Star Ratings.

BK Kajopaiye from CareFirst Blue Cross Blue Shield Kansas City said it best. “Identify members that are hungry, angry, lonely, or tired (HALT), to ensure you are addressing their life gaps before discussing quality, risk adjustment, and care.

Lauren Barca, VP of Quality and Stars at 86Borders emphasized the lack of standardized terminology for member outreach and relationship building. For instance, each plan or contract may have a different standard for “engagement.” Barca provides four valuable questions for health plans to consider when vetting member engagement partners or building their own teams.

  • How is outreach being conducted and are team persistent? Do teams give up when the member doesn’t answer?
  • Are members prematurely considered “unreachable” when they don’t respond to a mailing, text, or telephone call?
  • What additional steps are taken to locate members, build a trusted relationship, and fill SDOH needs that may be blocking access to care?
  • Once gaps are identified, how will the outreach team conduct proper interventions to fulfill those needs, educate members on benefits in their native language or level, and then close additional and remaining care gaps?

Shockingly, representatives from each plan mentioned that member outreach vendors almost always require limited or strict formats for data ingestion.

2. Build trust with providers to increase clinical data exchange

Data was another focal point for health plans’ need to build longitudinal health records and holistic member profiles. The need for more timely and extensive clinical data from providers was on every RISE attendee’s wish list.

While providers hold the keys to member data that health plans need, significant trust challenges between the two parties remain. From each session, here are the three foundational components for building trust in payer-provider clinical data sharing.

  • EHR concerns:
    • Providers lessen administrative burdens by listening to payers’ EHR complaints. Like acute care clinicians, health plans need timely access to accurate member data to do their jobs in healthcare.
    • Health plans build greater trust with providers by sharing intelligence gleaned from their data analytics. After ingesting provider data, health plans should review patient matching systems and share results with providers.
  • Value-based care:
    • Providers should ensure the proper resources and education are used to optimize their EHRs for value-based care.
    • By meeting with provider stakeholders, customer experience teams, and end users, health plans find new ways to support stakeholders and propel the adoption of value-based care models.
  • Interoperability:
    • Savvy providers understand they can offer opportunities and resources to payers. In turn, timely data collection and sharing of SDOH information tailors member outreach, enabling both parties to collaborate on closing care gaps.
    • Payers MUST provide value in turn. Plans can make sure data is available to physicians right when they need it and track patients throughout their health plan interventions.

I spoke with Mo Weitnauer, Chief Product Officer at MRO, who specializes in mediating and mending this relationship. She offers the following advice.

“Providers can lean on technology solutions to reduce the staff burden, facilitate timely exchange, achieve data quality, and maintain privacy. But payers, likewise, should consider new technology to support their vast requests for member data for engagement, quality reporting, and VBC models.” Weitnauer confirms that wellness improvement begins with more trusted relationships in healthcare.

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In closing remarks, Liz Haynes of Blue Cross and Blue Shield Kansas City, offered valuable questions health plans should address when it comes to building trust.

  • What do we need to stop doing that isn’t working?
  • How can we best provide data or streamline information? We must ask each other about data needs.
  • Where are we in the journey to improve care and how are we interpreting or understanding our role?

Looking back, RISE National 2024 offered ample strategies for providers, payers, and vendors. It also proved how trusted partnerships are at the root of all initiatives and organizational goals.

I look forward to reconvening at RISE National 2025 to hear about the increase in trusted collaboration, closed care gaps, interoperability strides, and improvement of data standardization, exchange, and quality in healthcare.